Law, policy, history and circumstance have all contributed to the odd state of affairs in which the DEA maintains that unless they say so, marijuana use has no therapeutic benefits whatsoever, regardless of its observed effects on patients with various physical maladies.
A significant group of marijuana users affected by scheduling decisions are individuals who use marijuana for therapeutic purposes. Their use of marijuana underscores the importance of Zinberg’s analytical perspective.
While the government has not acknowledged an accepted medical use for marijuana in the United States, significant numbers of citizens use marijuana as a therapeutic agent at their own risk. The legislative history insists that the impact of scheduling decisions on these individuals also be considered in this rulemaking procedure, irrespective of findings regarding marijuana’s medical use as a possible prescription substance. If marijuana does not have a significant dependence liability according to conventional medical standards, there is little justification for punishing medical use of marijuana by individuals on their own responsibility with criminal sanctions.
In 1993 Lester Grinspoon, also of the Harvard Medical School, published Marihuana, the Forbidden Medicine describing the illicit use of marijuana as a therapeutic agent.(14) Among the patients who describe their therapeutic use of marijuana is Stephen Jay Gould, the widely respected expert on evolutionary biology and widely published on scientific topics and process.
In 1989 the Administrator of DEA rejected the recommendation of an Administrative Law Judge that marijuana be placed in schedule II because the substance had an accepted medical use in the United States and was safe for use under medical supervision.(15) This decision was ultimately upheld by the U.S. Court of Appeals as within the Administrator’s discretion.(16)
In those proceedings, petitioners presented numerous affidavits and testimony regarding individuals’ therapeutic use of marijuana. According to DEA this information has no value.
“The evidence presented by the pro-marijuana parties regarding use of marijuana to treat various other ailments such as pain, decreased appetite, alcohol and drug addiction, epilepsy, atopic neuroderatitis, scleroderma and asthma was limited to testimony of individuals who had used marijuana for those conditions and the testimony of the psychiatrists or general practice physicians mentioned earlier. There is not a shred of credible evidence to support any of their claims.”(17)
Petitioners presented testimony of patients with multiple sclerosis whose use of marijuana allowed them to get up out of their wheelchairs and walk, when without the drug, they could not. According to DEA, these patients are suffering from drug-induced delusions.
“Why do scientists consider stories from patients and their doctors to be unreliable? First, sick people are not objective scientific observers, especially when it comes to their own health. We have all heard of the placebo effect. . . Second, most of the stories come from people who took marijuana at the same time they took prescription drugs for their symptoms . . . Third, any mind-altering drug that produces euphoria can make a sick person think he feels better. . . Fourth, long-time abusers of marijuana are not immune to illness. Many eventually get cancer, glaucoma, MS and other diseases. People who become dependent on mind-altering drugs tend to rationalize their behavior. They invent excuses, which they can come to believe, to justify their drug dependence.”(18)
The credibility of patient anecdotes depends on two corroborative factors. First, if marijuana does not have a significant dependence liability, then it does not have reinforcing effects that contribute to denial, which, as expressed by DEA, is when users “invent excuses, which they can come to believe, to justify their drug dependence.” The primary assessment of a drug’s ability to produce reinforcing effects is self-administration. As Cicero explains not all self-administration is harmful. Testimony of sufficient weight for an Administrative Law Judge to conclude that marijuana has an accepted medical use is of great relevance to the separate question of evaluating marijuana’s abuse potential.
DEA argues that expert testimony from scientists should concern the field of the scientist’s expertise.
“In reviewing the weight to be given to an expert’s opinion, the facts relied upon to reach that opinion and the credentials and the experience of the expert must be carefully examined. The experts presented by the pro-marijuana parties were unable to provide a strong scientific or factual basis to support their opinions. In addition, many of the experts presented by the pro-marijuana parties did not have any expertise in the area of research in the specific medical area being addressed.”(19)
A psychiatrist from the Harvard School of Medicine such as Dr. Lester Grinspoon is certainly qualified to evaluate the extent to which drug dependence has prejudiced a patient’s account of the therapeutic use of marijuana. Consequently his recent book on marijuana’s medical use is an expert’s account of the incidence of non-abusive use of marijuana in the United States. Grinspoon’s book and the full record of testimony in the case ultimately decided in ACT v. DEA provide valuable evidence of the scope, duration and significance of marijuana’s use as a therapeutic agent in the United States.
As this petition establishes, the dependence liability of marijuana is not a settled scientific issue; indeed this petition argues that there is substantial evidence that marijuana does not have a sufficient dependence liability to justify schedule I or II placement under United States law.
The second corroborative factor is the evidence provided by the discovery of the cannabinoid receptor system in the human brain, which provides a scientific explanation for the mechanisms of action behind marijuana’s therapeutic effects. As described above by the pioneers of the cannabinoid revolution, research on cannabinoids is now focused on developing the considerable therapeutic potential of this system and cannabinoid drugs.
When Hollister prepared his 1986 paper for the Pharmacological Reviews, he also reviewed the issue of marijuana’s therapeutic use. As cited above, he concluded that marijuana may prove to have greater therapeutic potential than other social drugs. In this passage, he elaborates on the therapeutic potential of marijuana.
“Therapeutic uses for marijuana, THC, or cannabinoid homologs are being actively explored. Only the synthetic homolog, nabilone, has been approved for use to control nausea and vomiting associated with cancer chemotherapy. While little doubt remains that marijuana, THC, and nabilone are effective for this use, the advent of other drugs that are equally effective but with fewer adverse effects may make this use moot. Use of marijuana to reduce intraocular pressure in patients with glaucoma requires a feasible topical preparation of cannabinoids. Although some cannabinoids have analgesic activity, the abundance of new opiod analgesics with little dependence liability provides tough competition. The use of marijuana as a muscle relaxant, though promising, has not yet been studied. Clinical studies to establish the efficacy of cannabidiol as an anticonvulsant or to compare it with other anticonvulsants are still to be done. Other therapeutic uses, such as treatment of bronchitis, migraine, anorexia, and alcoholism, are most unlikely prospects.”(20)
Hollister once served as the chairman of the Drug Evaluation Committee of the CPDD. In this 1986 passage he refers to “competition” between marijuana and other analgesics. Hollister states that there is “little doubt” that marijuana is effective as an anti-nausea agent. He refers to ongoing research on cannabidiol, one of the non-psychoactive constituent chemicals, regarding convulsions.(21) These comments establish that it is an underlying assumption of contemporary research that marijuana has therapeutic benefits, regardless of whether or not it has a legally defined “accepted medical use in the United States.”
Also in 1986, Raphael Mechoulam, in an interview with the International Journal of the Addictions, also confirms that marijuana has therapeutic potential.
“In summary, THC or cannabis may have important effects in the areas of pain control, as antiasthmatics, to treat glaucoma, and as part of cancer treatment as an antiemetic during chemotherapy. All these are important activities. Unfortunately, not much work is being done, certainly not when one compares it with what needs to be done. . .
“Knowing what I know today, I would have worked more on the therapeutic aspects of cannabis. This area apparently needs a major push that it has not had up ’till now, particularly given that it has therapeutic potential. One of the reasons that it has not been pushed was that most pharmaceutical companies years ago were afraid to go into that field. Companies were “burnt” working on amphetamines and LSD.”(22)
The 1990 article by Miles Herkenham, Allison Lynn and colleagues on the “Cannabinoid receptor localization in brain” also verifies that the therapeutic potential of marijuana is a fundamental assumption supporting modern cannabinoid research, and begins to provide a basis for understanding how this potential is realized.
“There are virtually no reports of fatal cannabis overdose in humans. The safety reflects the paucity of receptors in medullary nuclei that mediate respiratory and cardiovascular functions.
“Anticonvulsant and antiemetic effects of cannabinoids have therapeutic value. The localization of cannabinoid receptors in motor areas suggests additional therapeutic applications. Cannabinoids exacerbate hypokinesia in Parkinson disease but are beneficial for some forms of dystonia, tremor, and spasticity.”(23)
In a 1992 article published in the Annals of the New York Academy of Sciences, Herkenham made additional comments.
“The localization of cannabinoid receptors in motor areas suggests therapeutic applications. Cannabinoids exacerbate hypokinesia in Parkinson’s disease but are beneficial for some forms of dystonia, tremor, and spasticity. The association of cannabinoid receptors with GABAergic striatal projection neurons suggests roles for cannabinoids in control of movement, perhaps therapeutic roles in hyperkinesis and dystonia. Cannabinoids have been shown to be beneficial for some forms of dystonia and spasticity. . . Further work may show the basis for reported usefulness in controlling nausea and stimulating appetite in patients receiving chemotherapy for cancer or AIDS.”(24)
Abood and Martin confirm that:
“There have been reports to indicate that the cannabinoids may be effective in treating pain, convulsions, glaucoma, muscle spasticity, bronchial asthma, nausea and vomiting. These disorders are currently treated with drugs that are structurally distinct from cannabinoids . . .Obviously, new strategies are crucial for treating patients who are unresponsive to current therapy or suffer severe side-effects.”(25)
Martin and Abood express concern about the use of marijuana by individuals with already compromised immune systems. They note “the lack of conclusive evidence” of any adverse effect on the immune system, but express concern that findings from experimental research could be a source of alarm. Abood and Martin’s concern should be balanced by the statements of Herkenham above, and the explicit comments on marijuana’s effect on the immune system by Lynn and Herkenham above.
Further evidence that the therapeutic potential of marijuana is a fundamental assumption supporting contemporary research can be found in the newsletter of the National Institute on Drug Abuse, NIDA Notes. In an article discussing the discovery of “Marijuana’s Natural Counterpart”, the author points out that:
“Other NIDA-funded researchers are uncovering what appear to be other naturally occurring compounds that act like marijuana. Investigators believe that they will be able to show that these compounds help the body cope with stress, pain, and nausea.”(26)
Certainly when these scientists refer to therapeutic potential they mean that useful drugs can be developed from the study of marijuana. However their comments have additional value in that they verify that marijuana has therapeutic mechanisms of action. It is these mechanisms which scientists seek to better understand in order to unlock the pharmaceutical drug making potential of the cannabinoid family of chemicals. Regardless of the status of scientific knowledge about the action of marijuana on these therapeutic mechanisms, science has proved that these mechanisms actually exist. They are not figments of the dependence-produced craving of marijuana users experiencing serious organic illnesses.
Once again, regarding reports from marijuana users of medical benefits DEA maintains that “there is not a shred of credible evidence to support any of their claims.”(27) There is in fact substantial evidence to support their claims, as the above comments from professional pharmacological and medical journals indicate.
Policymakers have a legal obligation to consider the impact of prohibitive scheduling of marijuana on individuals who use the drug for its therapeutic potential at their own risk. Prohibitive scheduling calls for the criminal prosecution of patients who grow marijuana for personal medical use for the crime of manufacturing a controlled substance. Instead of arresting medical marijuana patients, their medical use of marijuana should be studied by the medical community to aid researchers in developing effective cannabinoid therapeutic agents.